Laserfiche WebLink
a '� 1��,s .APPLICATION FOR SANITATION PERMIT Permit Nd ----- 'j7 .... <br /> (Complete in Duplica+e) <br /> !• F � ,! Date Issued <br /> A plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County O di{ianc o. 549.. <br /> JOB ADDRESS AND �,pCATIO` ' - "' ---------------------------------•------ ----- <br /> 1 0 <br /> Owner's Name---`- L =�Lj ------------ ...... Phone-----------------------•-•---•---- <br /> Address------------ '.-!k{�.---- --- - ------------------------------------ -------------------­- •-----------...-----•------------ <br /> Contractor's Name--. - . ------ ------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ nnMptel ❑ Other ❑ <br /> Number of living units: --'---- Number of bedrooms _Z Numbe�—DObp'th <br /> aths .__/--_ Lot size U ---Z-�..�l--------------------- <br /> Water Supply: Public system " `Cammunity'syste`m`❑� P'5vate' to Water Table.._..---. ft. <br /> Character of soil to a depth of 3 feet: Sand / Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe Hardpan ❑ <br /> s <br /> Previous Application Made: Yes <br /> El New Construction: Yes No E]TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted i ublicseweiis available within 200 feet.) <br /> Sept Tank: Distance from nearest well-----------------Distance from fo#nclation--------------------Material-------------------------------------.- _-_-----. <br /> Q No. of compartments------------- --- .1-Size---------------- Liquid dept ---------- ---- ----------Capacity-------------�1--- �l <br /> g ndation ________ ___ ____Distance to nearest lot line-r_ <br /> l r t------.---- <br /> Dis os i Numaberofo�lnesearest w II_r.-------- Denath of each I Vie_-_______________ ____ Width of trencn._-- ------.---- <br /> p ! <br /> Type of filter mater Depth of filter mrterial--------/-- - -----Total length--------------i--�Q------_-----.- 1. <br /> - <br /> Seepage Pit: Distance to nearest weir-----_--_-_--_ Distance—from foundation-------------------.Distance to nearest lot line-----.-.------.__ <br /> -El. Number of pits Lining material size: Diameter. Depth <br /> Cesspool: Distance.;fro arest well-------------- Distance from foundation---.---_---.-_.---.Lining material--------------------------------------- <br /> ❑ Size: Di —leer --------------------------------- Depth-------------------------------------------------•--Liquid Capacity----------------------------gals. <br /> Privy: Dista'ncekfrom nearest well------------------------------------------------_Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-..------a---------- -----`-------------------- --------------•---------•-•------------------------------------- - <br /> I <br /> ----------- --------------•-•---------------------• --- --------------------------- - <br /> -• ----------------------------- ---------------------------------------•----------------------- ---------- <br /> F <br /> 1 hereby certify that I have p�epared this application and tha+ the work will be done.kaccor'dance with San Joaquin County <br /> ordinances, State laws, and rules:; d'regulations of the San Joaquin Local Health District:" <br /> (Signed)- x 1 . --` ------------------------------------- ----------------------------------------(Owner and/or Contractor] <br /> 4 . I� <br /> SY• ----- --------------------------------------=----------------------- --------(Title)--------------------------------------------- - ---------------- <br /> (Plot plan, showing size of lot, loc�lion of system in relation to waifs, buildings, etc., can be placed on reverse side). <br /> 1 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------- -------------------•-------------------- DATE :w ------ ------------------------------------- <br /> ---------------------------- <br /> REVIEWEDBY-------------------------------- -- - -- -------------------------------------------------------------------------------- DATE---- <br /> BUILDING PERMIT ISSUED._.. , ---•---------------------------------------------------------------------- DATE.---- Q&----------------------- <br /> Alterations and/,or recommendations: --------- - -- ---------------------- ; --------- .........----------............... -------------------•y------- ;� <br /> -------------- and/, <br /> °/- -------- – (� �a.' -.-` 'eru f!.. �t�---.--j - -lilt'L.... <br /> �-� ---------------------•-----------------------------------------------------•----------..----- <br /> - ----- .. . .. .. <br /> FINAL INSPECTION BY:- - ----- - Date------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North_"C" Street <br /> Stockton, California Lodi, California Manteca, California .. Tracy, California <br /> ES-9-2M 10-52 Revised W.2100 � <br />